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Three Wishes

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It’s the classic start to a well-rehearsed story, but when Genie Peter appeared before me I still couldn’t believe my eyes. My disbelief lasted longer than it should because he didn’t look like the usual genie, arising like a wraith from an old and battered brass lamp.  Dressed in an immaculate suit, he appeared as I was cleaning my memento of Parliament House.

“Hello”, he said, holding out his hand with a firm handshake. “I am Genie Peter and you have three wishes, but I’m a bit new to this Genie business and they have to be related to health, because my powers only work at the moment across that portfolio.”

I thought quickly in case he disappeared. My own health is good, so what would make the greatest difference to doctors and their patients in coming years?

“Okay”, I said.  “Can you ensure there is a medical workforce plan that roughly matches the number of medical graduates to available positions through the training pipeline? We need this to ensure Australia has the fully trained GPs and other specialists we need in the future, and to avoid wasting the expensive investment we have made in medical graduates.”

“That sounds reasonable and makes sense”, said Genie Peter, “but I’ll need to work with other health genies from around the country and that can be hard.”

“This is really important”, I said.  “Without a well trained medical workforce it will be hard to deliver the medical services Australia needs in the future.”

“Right”, said Genie Peter.  “Your wish is granted and we’ll give it a really good crack.  I hope your second wish is a bit easier.”

“It is”, I said. “Can you please remove the $2000 cap on tax deductions for education expenses?  Doctors need to continually update their knowledge and skills. It is a requirement for them to maintain their medical registration so they can continue to work, so it is an essential business expense. But more importantly, it is so their patients get up to date diagnoses and treatment. Of course, it is not just medicine that is affected, but all health professions and the Australian workforce as a whole. Surely the Prime Genie doesn’t want Australia to be known as the dumb and dumber country? Also, the $2000 cap would batter Australia’s education and conference industries. The cap has already been deferred by the previous Treasurer, Genie Chris, to 1 July 2015, so that gives plenty of time to review the regulations on tax claims, but the cap should go.”

Genie Peter paused for a moment. “I’m not sure this is strictly about health, but I can see that it will impact on health services and all health professionals”, he said. “I will need to speak to Genie Joe, but take it that your wish is granted. I hope your last wish is something that lies entirely within my portfolio.”

“It is”, I said. “It relates to general practice, and since primary care is a Commonwealth responsibility, this is all yours.”

I could see he was looking concerned at the prospect of not having anyone else to blame if things went wrong.

“Don’t worry”, I said. “Australian general practice does a great job, and plays a major part in achieving the outstanding population health outcomes that Australians enjoy. But they are doing it tough. Increased patient expectations, more demand for teaching in general practice, more exacting accreditation standards, increasing business overheads while their patients’ rebates from the MBS have fallen from 71 per cent to 49 per cent of the AMA consultation fee.”

“I hadn’t appreciated it was quite that bad”, said Genie Peter, “and anyway, we are planning to review Medicare Locals.

To which I replied, “This isn’t just about Medicare Locals or the not-so-super clinics. What about engaging with general practitioners to develop a vision for how Australian general practice should develop over the next five to 10 years? The AMA Council of General Practice has plenty of constructive ideas and, above all this, has the potential, if not to reduce health care spending in real terms, at least to produce some levelling off.”

A big smile came over the face of Genie Peter as he said, “That’s just what Genie Joe wants to hear. Your suggestion is just a first step, but your wish is granted.”

With that, Genie Peter disappeared and I woke up. It was of course just a dream … but it could be much more than that.

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